Diagnosis Of Dementia In Patients Research Articles

Efectividad de la resonancia magnética cerebral en el diagnóstico precoz y caracterización de las demencias: revisión sistemática

IntroductionMagnetic resonance imaging (MRI) is a frequently used test in the diagnosis of dementia. The objective was to evaluate its effectiveness for the early diagnosis of dementia in patients with mild cognitive impairment (MCI). Material and methodsOriginal studies were selected from systematic reviews between 2011 and 2021, according to PRISMA 2020 criteria. QUADAS-2 and GRADE tools were used, and a meta-analysis was performed. ResultsFinal selection of 23 articles. Patient selection and index test had a high probability of bias. The certainty of the evidence was very low. In the hippocampus, sensitivity was 0.62 (95%CI 0.48-0.79) and specificity 0.70 (95%CI 0.55-0.80). In the temporal lobe, sensitivity was 0.65 (range 0.45) and specificity 0.69 (range 0.32). ConclusionsThere is insufficient evidence to recommend routine brain MRI for the early diagnosis of dementia in patients with MCI.

Process validation and preclinical development of a new PET cerebral blood flow tracer [11C]MMP for initial clinical trials

Background2-deoxy-2-[18F]fluoro-D-glucose ([18F]FDG) is commonly used for diagnosis of dementia because brain glucose metabolism reflects neuronal activity. However, as [18F]FDG is an analogue of glucose, accumulation of tracer in the brain is affected by plasma glucose levels. In contrast, cerebral blood flow (CBF) tracers are theoretically unaffected by plasma glucose levels and are therefore expected to be useful alternatives for the diagnosis of dementia in patients with diabetes. The techniques currently used for CBF imaging using single photon emission computed tomography (SPECT) and [15O]H2O positron emission tomography (PET), but these are limited by their insufficient resolution and sensitivity for regional brain imaging, especially in patients with brain atrophy. N-isopropyl-4-[11C]methylamphetamine ([11C]MMP) is a possible CBF tracer with high resolution and sensitivity that exhibits comparable performance to that of [15O]H2O in conscious monkey brains. We performed process validation of the radiosynthesis and preclinical development of [11C]MMP prior to clinical translation.ResultsThe decay-corrected yields of [11C]MMP at the end of synthesis were 41.4 ± 6.5%, with 99.7 ± 0.3% radiochemical purity, and 192.3 ± 22.5 MBq/nmol molar activity. All process validation batches complied with the product specifications. The acute toxicity of MMP was evaluated at a dose of 3.55 mg/kg body weight, which is 10,000 times the potential maximum clinical dose of [11C]MMP. The acute toxicity of [11C]MMP injection at 150 or 200 times, to administer a postulated dose of 740 MBq of [11C]MMP, was also evaluated after the decay-out of 11C. No acute toxicity of MMP and [11C]MMP injection was found. No mutagenic activity was observed for MMP. The effective dose calculated according to the Medical Internal Radiation Dose (MIRD) method was 5.4 µSv/MBq, and the maximum absorbed dose to the bladder wall was 57.6 µGy/MBq. MMP, a derivative of phenylalkylamine, showed binding to the sigma receptor, but had approximately 1/100 of the affinity of existing sigma receptor imaging agents. The affinity for other brain neuroreceptors was low.Conclusions[11C]MMP shows acceptable pharmacological safety at the dose required for adequate PET imaging. The potential risk associated with [11C]MMP PET imaging is well within the acceptable dose limit.

Care trajectories around a first dementia diagnosis in patients with serious mental illness.

To develop a typology of care trajectories (CTs) 1 year before and after a first dementia diagnosis in individuals aged ≥65 years, with prevalent schizophrenia or bipolar disorder. This was a longitudinal, retrospective cohort study using health administrative data (1996-2016) from Quebec (Canada). We selected patients aged ≥65 years with an incident diagnosis of dementia between 1 January 2014 and 31 December 2016, and a diagnosis of schizophrenia and/or or bipolar disorder. A CT typology was generated by a multidimensional state sequence analysis based on the "6 W" model of CTs. Three dimensions were considered: the care setting ("where"), the reason for consultation ("why") and the specialty of care providers ("which"). In total, 3868 patients were categorized into seven distinct types of CTs, with varying patterns of healthcare use and comorbidities. Healthcare use differed in terms of intensity, but also in its distribution around the diagnosis. For instance, whereas one group showed low healthcare use, healthcare use abruptly increased or decreased after the diagnosis in other groups, or was equally distributed. Other significant differences between CTs included mortality rates and use of long-term care after the diagnosis. Most patients (67%) received their first dementia diagnosis during hospitalization. Our innovative approach provides a unique insight into the complex healthcare patterns of people living with serious mental illness and dementia, and provides an avenue to support data-driven decision-making by highlighting fragility areas in allocating care resources. Geriatr Gerontol Int 2024; 24: 577-586.

Post-stroke dysphagia and ambient air pollution are associated with dementia.

This cohort study aimed to explore the potential association between ambient air pollution and dementia incidence in adults who have experienced a stroke. Additionally, the study aimed to determine dysphagia as a predictive factor for the subsequent development of dementia in patients with stroke. This retrospective nested case-control study used data from the Kaohsiung Medical University Hospital Database in Taiwan. Data collected include average ambient air pollution concentrations within 3 months and 1 year after the index dysphagia date. The primary outcome includes incident dementia in patients with or without dysphagia. Logistic regression analysis was performed to examine the association between significant air pollution exposure and the risk of dementia while controlling for baseline demographic characteristics (age and sex), and comorbidities. The univariable regression models revealed a higher likelihood of dementia diagnosis in patients with dysphagia (odds ratio = 1.493, 95% confidence interval = 1.000-2.228). The raw odds ratios indicated a potential link between air pollution exposure and elevated dementia risks in the overall study population and patients with stroke without dysphagia, except for O3. Particulate matter (PM)2.5 and nitrogen oxides (NOx) exhibited significant effects on the risk of dementia in the stepwise logistic regression models. The presence of dysphagia following a stroke may pose a risk of developing dementia. Additionally, PM2.5 and NOx exposure appears to elevate the risk of dementia in patients with stroke.

Anterior cervical discectomy and fusion in patients with preexisting dementia: Increased medical complications, costs, and 90-day readmissions

Study designRetrospective-Cohort IntroductionDementia is among the most common health concerns for the aging population, characterized by steep cognitive decline and subsequent loss of independence. Limited orthopedic literature examines the influence that dementia has on patients undergoing elective spinal surgeries. MethodsEmploying the PearlDriver Database, a study population consisting of patients who underwent primary elective ACDF with a prior diagnosis of dementia were selected using Internal Classification Disease-9 (ICD) and ICD-10 codes. Patients with a history of trauma, infection, or malignancy were excluded. Patients with dementia were compared to matched controls via logistical regression accounting for patient demographics, medical comorbidities and levels operated on. Patients were assessed for 90-day outcomes including medical complications, emergency department visits, readmissions, one-year reoperation, hospital length of stay (LOS) and total operative hospitalization costs, and 90-day postoperative cost. ResultsThere were 4104 patients in the dementia group and 20,269 patients in the matched control group who underwent primary ACDF. Multivariate analysis showed that patients with dementia undergoing ACDF were associated with increased 90-day major and minor medical complications (p < 0.001). Patients with dementia were also associated with an increased risk of dysphagia (p < 0.001), 90-day ER visits(p < 0.001), 90-day readmissions(p < 0.001), and increased LOS(p < 0.001) following ACDF compared to the control group. Additionally, both total hospitalization costs and 90-day postoperative costs were higher in the dementia cohort(p < 0.001). ConclusionPreoperative dementia diagnosis in patients undergoing ACDF is associated with increased number of readmissions, hospitalization and 90-day costs, and postoperative medical complications. Level of evidence3

Screening diagnosis of dementia in patients following heart failure decompensation is associated with a higher relative wall thickness.

The usefulness of echocardiographic characteristics for dementia prediction in patients with heart failure decompensation (HFD) is not determined. Therefore, we sought to investigate the echocardiographic features of patients with HFD and screening diagnosis of dementia (SDD). 139 patients aged over 65 years were hospitalized with the diagnosis of HFD. Clinical characteristics and echocardiographic characteristics were recorded during hospitalization. SDD was defined based on the result of ALFI- MMSE of <17 points. Patients with SDD were older (p=0.013), had thicker IVSd (p=0.021), thicker PWd (p=0.005) and had a higher RWT (0.40 vs 0.35, p=0.004) than patients without SDD, without differences in LVMI (p=0.13). There was no correlation between RWT and LVMI (r=-0.01, p=0.88). In the multivariate analysis, an older age (β=-0.116, 95% CI -0.224 - -0.008, p=0.035, per year) and a higher RWT (β=-0.069, 95% CI -0.137 - -0.002, p=0.045, per 0.01) influenced a lower ALFI-MMSE. For a prediction of SDD, the RWT reached the area under a ROC curve of 0.67 (95% CI 0.56-0.77, p=0.004 with sensitivity of 60% and specificity of 70% for RWT of ≥0.375). Apart from age, RWT reflecting left ventricular geometry changes but not hypertrophy was independently but moderately associated with SDD in patients following HFD (Tab. 4, Fig. 1, Ref. 35).

Are we adequately reviewing confusion inducing drugs in patients referred to the memory assessment service?

AimsThe aim of this quality improvement evaluation project is to establish the standard of current practice in relation to reviewing confusion inducing drugs (CIDs) at the time of referral, as it has been hypothesised that these medications contribute to short term cognitive impairment. This is essential in order to establish the validity of the diagnostic processes of dementia syndrome in the memory assessment services.BackgroundIt has long been established that anti-cholinergic medications (ACMs) have contributed to short-term cognitive impairment in patients taking them. This is compounded with the fact that these medications may be continued without review, for longer than was originally intended. The impact of polypharmacy, subsequent anti-cholinergic burden, and the overlapping presence of delirium, may call into question the validity of a diagnosis of dementia in patients who have not been correctly vetted during the course of their assessment. This quality improvement evaluation aims to assess whether patients’ medications are being reviewed before diagnosing a memory disorder. This is in accordance with guidance set out by the NG97 NICE guidelines, The Royal College of Psychiatrists Memory Service National Accreditation Programme (MSNAP), and the National Institute on Ageing and Alzheimer's Association (NIA-AA).MethodAll new referrals to the memory assessment service during July and August 2019 were systematically reviewed and data extracted from the memory referral document and entries on RIO from first point of contact. The following data were recorded: patient ID, GPCOG/6CIT score, final diagnosis, CID prescriptions and CID review.ResultThe results were collated using a data-set of 216 patients (136 females and 80 males,) of which the mean age was 79 years. It was noted that 36% of patients had not had any sort of cognitive assessment before referral, which identifies an area for improvement. However the most substantial finding was that only 10 patients (5%) had a CID prescription review documented in the RIO notes.ConclusionOur data suggest that in our memory assessment service, only a small proportion of patients are having a documented review of their CIDs prior to diagnosis of dementia. In order to improve this and thus improve compliance with guidelines from the Royal College of Psychiatrists MSNAP and the NIA-AA, measures will be taken to issue each dementia support worker and nurse with a CID prescription review card, which will list those medications to consider and flag for review.

The Use of MicroRNAs for the Early Diagnosis of Dementia in Patients Affected by Hearing Loss

The Use of MicroRNAs for the Early Diagnosis of Dementia in Patients Affected by Hearing Loss

A Study of Heart Failure Patients and their Blood Pressure Trends Preceding Dementia Diagnosis

Introduction: Blood pressure and perfusion of the brain are central components of neurological health that are often influenced by Heart Failure. However, the connection between blood pressure and the development of dementia is not clearly understood. Aim of the study: The aim of this retrospective study was to assess blood pressure trends in older heart failure patients and evaluate whether they developed dementia over the course of a five-year period. Methods: This retrospective case-control study analyzed blood pressure changes preceding the diagnosis of dementia in patients over the age-of-60. Blood pressures were obtained from the date of dementia diagnosis, and then one-year and five years before diagnosis. Study “controls” were age-matched patients without dementia, using the mean-age-of dementia diagnosis as the first data point. Results: 67.2% of patients with a dementia diagnosis had experienced a decrease in systolic pressure up to 5-years prior to their diagnosis, as compared to 46.6% of patients who had not been diagnosed by the same age. Similarly, in the one-year preceding the diagnosis, 62.7% of patients with dementia showed a decreasing systolic pressure over the time period, as compared to 50.0% of those who did not develop dementia. Additionally, there was a significant difference (p<0.001) in the dementia rates between African American and Caucasian subgroups (55.0% African Americans vs. 31.0% Caucasians). Conclusions: Patients with dementia were more likely to have decreasing systolic pressure trends compared to age-matched patients without dementia and appeared to have significantly lower systolic pressures one-year-before dementia diagnosis. Lower systolic pressure can potentially reduce the perfusion pressure of the brain and cause subtle cerebral ischemia, leading to cognitive decline. It is very important that healthcare providers monitor these trends and risk factors as they manage blood pressures in geriatric patients.

Acute Healthcare Utilization of a Multidisciplinary Neurocognitive Dementia Patient Cohort.

Background and PurposeUpon referral from the primary care provider (PCP), dementia is diagnosed either by a neuropsychological evaluation (NPE) or at a multidisciplinary neurocognitive clinic (MNC). Following the NPE, patients continue receiving care from their PCP. In contrast, patients at the MNC are followed by a multidisciplinary care team that provides expertise across specialties in dementia care and education for the patient, family members, and care providers. The purpose of the study was to determine the utilization of acute healthcare services during the 2 years following a diagnosis of dementia in patients from the MNC and NPE.MethodsA retrospective review was performed of 581 electronic medical records from January 2010 through December 2014 for 2 cohorts of patients diagnosed with dementia 1) by a neuropsychologist or 2) in a MNC. Acute-care hospital admissions, emergency room (ER) visits, and nonroutine PCP visits were identified. Categorical demographics and utilization variables were summarized by frequency. Chi-square analysis was used to analyze demographic characteristics and overall utilization between MNCs and NPE. Utilization in comparison with various demographic characteristics was analyzed using Spearman correlation coefficients and negative binomial regressions.ResultsPatients evaluated in the MNC were older, more severely impaired, and lived alone more often compared with NPE patients, but there was no increase in hospital admissions and ER visits. Patients who underwent NPE were 1.58 times more likely to have a nonroutine PCP office visit than patients evaluated in the MNC (p=0.0093).ConclusionsPerforming follow-up in multidisciplinary clinics provides patients with more education and may help to reduce the utilization of healthcare services.

BLOOD PRESSURE TRENDS PRECEDING DEMENTIA: A STUDY OF HEART FAILURE PATIENTS

Blood pressure and perfusion of the brain are central components of neurological health that are often influenced by heart failure. This retrospective case-control study analyzed blood pressure changes preceding the diagnosis of dementia in patients over the age of 60. Blood pressures were obtained from the date of dementia diagnosis, and then one year and five years before diagnosis. Study “controls” were age-matched patients without dementia, using the mean age of dementia diagnosis as the first data point. Over the five-year period preceding diagnosis, 67.2% with dementia showed decreasing systolic pressure compared to 46.6% of patients without dementia. Similarly, 62.7% with dementia showed a decreasing systolic pressure over the one-year period, compared to 50.0% of those without dementia. Additionally, there was a significant difference (p < 0.001) in the dementia rates between African American and Caucasian subgroups (55.0% African Americans vs. 31.0% Caucasians). Patients with dementia were more likely to have decreasing blood pressure trends than age-matched patients without dementia and appeared to have significantly lower blood pressures one year before the diagnosis. It is crucial that providers are cognizant of these trends and risk factors for dementia as they manage blood pressures in geriatric patients.

Validation of the Parkinson's Disease-Cognitive Rating Scale Applying the Movement Disorder Society Task Force Criteria for Dementia Associated with Parkinson's Disease.

The authors studied the measurement properties of the Parkinson's Disease-Cognitive Rating Scale (PD-CRS) compared with Movement Disorders Society Task Force (MDS-TF) criteria for the diagnosis of dementia in patients with Parkinson's disease. The sample consisted of 223 patients who were diagnosed in accordance with the United Kingdom Parkinson's Disease Society Brain Bank who were assessed with both the MDS-TF and the PD-CRS criteria (in addition to other instruments) without the assessors' knowledge of previous results. Internal consistency was studied (homogeneity of the items and Guttmann's λ values were obtained) in addition to convergent, divergent, and discriminative validity. The receiver operating characteristic curve was obtained, and the cutoff point at which the PD-CRS had the greatest efficiency was analyzed. The internal consistency was shown to be adequate, with a λ value of 0.821. A floor effect was observed in 4 of the items (Sustained Attention, Working Memory, Immediate Verbal Memory, and Alternating Verbal Fluency), and 1 item showed a ceiling effect (Clock Copying). The scale adequately discriminated patients with and without dementia (Kruskal-Wallis; P≤0.000). The area under the curve was 0.899. With a cutoff score of 62 (from a possible score of 134), the scale achieved 94% sensitivity and 99% specificity. The PD-CRS has adequate measurement properties and is a valid tool for studying the presence of dementia in patients with Parkinson's disease.

An analysis of the cognitive items of the movement disorders society checklist for the diagnosis of dementia in patients with Parkinson's disease.

Some studies about the Movement Disorders Society checklist for the diagnosis of Parkinson's disease (PD) dementia (PDD) suggested that its accuracy was not totally satisfactory. Our study focused to evaluate the two items of the checklist related to the cognitive assessment. We assessed 95 consecutive patients with a diagnosis of PD using the UPDRS, Hoehn and Yahr, Schwab and England scales, Pfeffer Functional Activities Questionnaire, MMSE, Clinical Dementia Rating, clock drawing test, verbal fluency test (animals), digit span, word list battery of CERAD, Frontal Assessment Battery and the 15-item Geriatric Depression Scale The cognitive diagnosis was based on the MDS diagnostic criteria for PDD. The checklist was completed later by a blinded investigator. The data were evaluated using descriptive analysis and calculation of sensitivity, and specificity of the checklist for the diagnosis of PDD. 33 patients (35%) were diagnosed with PDD. The ROC curve showed that the MMSE cut-off score < 26 had the highest accuracy (sensitivity: 94%, specificity: 55%) for the diagnosis of PDD. Using the checklist with original cut-off scores we found sensitivity of 97% and specificity of 58%. Using an alternative way to interpret the cognitive assessment of the checklist we found sensitivity of 94% and specificity of 89% for the diagnosis of PDD. Our findings suggest that to improve the accuracy of the checklist, it would be necessary to adjust the way we use and interpret the cut-off scores of the MMSE and of the subtests, without the need to eliminate their use.

(123)I-FP-CIT SPECT imaging in early diagnosis of dementia in patients with and without a vascular component.

Alzheimer’s disease (AD) and vascular dementia (VaD) are the most common cause of dementia. Cerebral ischemia is a major risk factor for development of dementia. 123I-FP-CIT SPECT (DaTScan) is a complementary tool in the differential diagnoses of patients with incomplete or uncertain Parkinsonism. Additional application of DaTScan enables the categorization of Parkinsonian disease with dementia (PDD), and its differentiation from pure AD, and may further contribute to change the therapeutic decision. The aim of this study was to analyze the vascular contribution towards dementia and mild cognitive impairment (MCI). We evaluated the utility of DaTScan for the early diagnosis of dementia in patients with and without a clinical vascular component, and the association between neuropsychological function, vascular component and dopaminergic function on DaTScan. One-hundred and five patients with MCI or the initial phases of dementia were studied prospectively. We developed an initial assessment using neurologic examination, blood tests, cognitive function tests, structural neuroimaging and DaTScan. The vascular component was later quantified in two ways: clinically, according to the Framingham Risk Score (FRS) and by structural neuroimaging using Wahlund Scale Total Score (WSTS). Early diagnosis of dementia was associated with an abnormal DaTScan. A significant association was found between a high WSTS and an abnormal DaTScan (p < 0.01). Mixed AD was the group with the highest vascular component, followed by the VaD group, while MCI and pure AD showed similar WSTS. No significant associations were found between neuropsychological impairment and DaTScan independently of associated vascular component. DaTScan seems to be a good tool to discriminate, in a first clinical assessment, patients with MCI from those with established dementia. There was bigger general vascular affectation observable in MRI or CT in patients with abnormal dopaminergic uptake seen on DaTScan.

Cerebrospinal Fluid Aβ1-40 Improves Differential Dementia Diagnosis in Patients with Intermediate P-tau181P Levels

It is assumed that the concentration of amyloid-β1-40 (Aβ1-40) in cerebrospinal fluid (CSF) reflects the total amount of Aβ protein in the brain and thus allows a better interpretation of inter-individual differences in Aβ quantity than the Aβ1-42 concentration. In this study, Aβ1-40 was added to the existing CSF biomarker panel of Aβ1-42, total tau (T-tau), and phosphorylated tau (P-tau181P) in order to test whether the accuracy of the differential dementia diagnosis improved. The concentration of Aβ1-40 (INNOTEST® β-amyloid(1-40) prototype version, Innogenetics NV, Belgium) and the other biomarkers (INNOTEST®) was determined in CSF samples from 80 Alzheimer's disease (AD) patients, 75 non-AD dementia patients, and 30 controls. A large proportion of the study population had autopsy-confirmed neurodegeneration (AD: 73/80 = 91%; non-AD: 38/75 = 51%). The levels of Aβ1-40 were decreased in AD (10856 ± 4745 pg/mL) and non-AD patients (10519 ± 4491 pg/mL) when compared to controls (14760 ± 7846 pg/mL) (p = 0.002 and p = 0.001). The Aβ1-42/Aβ1-40 ratio was significantly decreased in AD (0.043 ± 0.021) as compared to non-AD patients (0.064 ± 0.027; p < 0.001) and controls (0.053 ± 0.023; p < 0.001). In order to differentiate AD from non-AD patients, a decision tree was constructed. The diagnostic accuracy of the decision tree that contained Aβ1-42, Aβ1-40, P-tau181P, and the Aβ1-42/Aβ1-40 ratio was significantly better than the diagnostic accuracy (80% versus 74%) of the decision tree without Aβ1-40 and the Aβ1-42/Aβ1-40 ratio (p < 0.001). In conclusion, no difference in Aβ1-40 CSF levels was found between AD and non-AD patients, but adding CSF Aβ1-40 and the CSF Aβ1-42/Aβ1-40 ratio to a biomarker-based decision tree, might have an added value for discriminating AD from non-AD patients in case of intermediate CSF P-tau181P values.

2286 – The difficulty of diagnosing dementia in patients with intellectual disability: experience from a UK memory clinic

The prevalence rate of dementia in older adults with intellectual disability (ID) is comparable with that of the general population and is significantly higher in people with Down Syndrome (DS). It is recommended that diagnosis should be made following history, physical and mental state examination, cognitive assessment, blood tests and, ideally, neuroimaging. However, experience suggests that dementia may be underdiagnosed in this patient group thereby restricting access to appropriate management. We aimed to elucidate the barriers to a timely diagnosis of dementia in the ID population attending a specialised ID memory clinic in London, UK. We conducted a service review of the Clinic, retrospectively reviewing the records of all patients seen in 2011 to assess attendance and diagnosis rate, co-morbid physical and mental illness and the completion of neuroimaging and blood tests. 32 patients were seen at least once during 2011 in the memory clinic, of whom 11 (34%) received a diagnosis of dementia. 22 (69%) of those seen had DS and 18 (56%) were male. 12 (38%) patients have thyroid dysfunction and 8 (25%) have epilepsy. 23 patients had completed a DLD in the past year and 14 (44%) had completed more than one DLD. 12 (38%) patients had a previous brain scan and 27 (84%) patients had had blood tests in the previous year. Comorbid physical illnesses, consistent attendance at appointments, access to psychological assessment and willingness to undergo neuroimaging and phlebotomy are significant barriers to diagnosis of dementia in patients with ID.

Comorbid Depression Is Associated with an Increased Risk of Dementia Diagnosis in Patients with Diabetes: A Prospective Cohort Study

Comorbid Depression Is Associated with an Increased Risk of Dementia Diagnosis in Patients with Diabetes: A Prospective Cohort Study

Comorbid Depression Is Associated with an Increased Risk of Dementia Diagnosis in Patients with Diabetes: A Prospective Cohort Study

Both depression and diabetes have been found to be risk factors for dementia. This study examined whether comorbid depression in patients with diabetes increases the risk for dementia compared to those with diabetes alone. We conducted a prospective cohort study of 3,837 primary care patients with diabetes (mean age 63.2 +/- 13.2 years) enrolled in an HMO in Washington State. The Patient Health Questionnaire (PHQ-9) was used to assess depression at baseline, and ICD-9 diagnoses for dementia were used to identify cases of dementia. Cohort members with no previous ICD-9 diagnosis of dementia prior to baseline were followed for a 5-year period. The risk of dementia for patients with both major depression and diabetes at baseline relative to patients with diabetes alone was estimated using cause-specific Cox proportional hazard regression models that adjusted for age, gender, education, race/ethnicity, diabetes duration, treatment with insulin, diabetes complications, nondiabetes-related medical comorbidity, hypertension, BMI, physical inactivity, smoking, HbA(1c), and number of primary care visits per month. Over the 5-year period, 36 of 455 (7.9%) patients with major depression and diabetes (incidence rate of 21.5 per 1,000 person-years) versus 163 of 3,382 (4.8%) patients with diabetes alone (incidence rate of 11.8 per 1,000 person-years) had one or more ICD-9 diagnoses of dementia. Patients with comorbid major depression had an increased risk of dementia (fully adjusted hazard ratio 2.69, 95% CI 1.77, 4.07). Patients with major depression and diabetes had an increased risk of development of dementia compared to those with diabetes alone. These data add to recent findings showing that depression was associated with an increased risk of macrovascular and microvascular complications in patients with diabetes.

Identifying depression in older adults via video consultation

Background: A project aimed to identify the reliability of the diagnosis of dementia via video consultation (VC) also collected data regarding the diagnosis of depression via video conferencing. Methods: This was a multi-site study in which a specialist carried out a cognitive assessment via VC with the patient and their carer. A second interview was carried out face to face (FTF) by a second specialist on the same day. This VC/FTF pairing was referred to as VF. Inter-rater reliability was assessed between specialists by using overall proportional agreement (PO) and kappa (k). Data on the presence of depression were collected from each specialist. Results: One hundred fifty-five participants, referred by their general practitioner for a specialist assessment at one of four participating Memory Disorder Clinics (MDCs), were divided into two groups: VF (n = 82) or FTF (n = 73). Seventy-five were men. The average age was 76 years (standard deviation [SD], 9; 54 to 95). The mean Standardised Mini-Mental State Examination Score was 23.8 (SD, 4.4; 8 to 30). Overall agreement via VC (PO = 0.793; k = 0.37; P = .12) was at similar levels to agreement for FTF (PO = 0.767; k = 0.31, P = .13). Conclusions: The identification of depression in this patient group was a secondary analysis within a study designed to examine the reliability of the diagnosis of dementia in patients referred to an MDC. The results suggest that recognizing depression via VC is reliable, but further studies are required because this population is not representative of a typical population in which the suitability of VC for the diagnosis of depression would be tested.Copyright c 2009 The Alzheimer's Association Published by Elsevier B.V.

Is depression in elderly people followed by dementia? A retrospective cohort study based in general practice.

We used a retrospective cohort study design to test the hypothesis of a relation between old-age depression and subsequent dementia. The study sample comprised 19103 patients aged 50 or more and born after 1910, included in a family-practice-based registration network. We estimated odds ratio (OR) and 95% confidence interval (95% CI) for a diagnosis of dementia in patients with or without previous late-onset depression and survival analysis, including hazard ratios resulting from Cox regression analysis. The OR for a diagnosis of dementia subsequent or not to late-onset depression was found at survival analysis: p = 0.26 (log rank test). Hazard ratio for patients with and without previous old age depression and subsequent dementia in patients aged 50 or more and born after 1910. This supports the hypothesis of old-age depression being a predictor, and possibly a causal factor, of subsequent dementia.